Opioid crisis began with a lie about the risks [Opinion]

2of 2The scourge of opioid addiction is a national emergency with no end in sight. More people die each month from opoids than died in the terrorist attack on Sept. 11, 2001.Photo: Toby Talbot, STF / Associated Press

Opioid overdose is the leading cause of accidental death in the United States.

In 2016 alone, opioid overdose caused 65,000 deaths, 3,000 of which were in Texas. That statewide number is probably higher, since only 13 of 254 counties reported this accurately.

Americans are 5 percent of the world population, but consume 80 percent of the world’s hydrocodone. Between 2013 and 2016, fentanyl overdoses increased 540 percent.

The opioid epidemic cost the nation $504 billion in 2015 — 2.8 percent of our GDP. The cost in Texas is $20 billion.

The trigger of the opioid crisis was a misrepresentation of a 1980 letter published in the New England Journal of Medicine, reporting on 11,000 hospitalized patients receiving opioids. It concluded that “despite widespread use of narcotic drugs in hospitals… addiction is rare in medical patients with no history of addiction.” This became a landmark study, cited more than 600 times, particularly after Purdue Pharma introduced OxyContin (extended-release oxycodone) in 1995.

Large opioids manufacturers began funding nonprofit groups such as the American Pain Society; and pain experts advocated for pain to become an important “fifth vital sign” to be queried in every doctor’s visit when checking blood pressure, heart rate, respiration and temperature.

Caught in the trend, the Federation of American Medical Boards encouraged punishing physicians for under-treating pain. This policy was drafted by individuals with ties to opioids manufacturers. Some were members of industry speakers’ bureaus, and later became company executives.

Purdue funded more than 20,000 educational programs between 1996 and 2002 to influence physician prescription habits nationwide, and developed a misleading advertising campaign that claimed that the risk of addiction from prescription opioids was “much less than 1%.” OxyContin sales grew from $48 million in 1996, to over $1.5 billion in 2002. With increased sales came increased abuse and addiction. By 2004, OxyContin was the leading drug of abuse in the United States.

In 2007, Purdue (and three executives) pleaded guilty to misrepresenting the risks of OxyContin addiction and paid $634 million in penalties, a fraction of the $35 billion in sales in two decades.

Manufacturers of more potent opioids perpetuated the crisis. For example, Insys Pharmaceuticals derives most of its revenue from Subsys fentanyl, an opioid sublingual spray 100 times more potent than morphine. Though indicated for breakthrough cancer pain, only 1 percent of prescriptions were written by oncologists.

So what can we do to stem the tide of death and put an end to the opioid crisis? Consider these seven policy recommendations:

First, many physicians feel pressure to overprescribe opioids due to linkage of reimbursements to patient satisfaction with pain control. The medical industry needs to alleviate this pressure. In a good first step, theAmerican Medical Association and the American Academy of Family Physicians voted to drop pain scores as a fifth vital sign.

Second, clinicians needs to limit the opioid prescriptions length for acute pain and promote a multimodal non-opioid stategy. In 2016 the CDC started moving in this direction by advocating the preferential use of non-opioid therapies as a front-line treatment of chronic non-cancer pain.

Third, we need to bridge the gap between drug addiction and treatment. Only one in 10 addicted people receive specialized treatment. The Trump administration pledged to bolster opioid addiction research and treatment by $13 billion over the next two years. However, efforts to roll back the Affordable Care Act threaten to reduce access to these services. If we want to expand treatment, then we have to expand health care coverage.

Fourth, more research is needed into new, novel drugs to help control addiction and reverse opioid overdoses. Current therapies, such as methadone or buprenorphine/naloxone, only work in half of addiction cases.

Fifth, the medical industry and government need to recognize the usefulness of non-opioid pharmacologic approaches, particularly cannabinoids — also known as medical marijuana. Cannabinoids use to modulate chronic pain is unproven, but they could reduce opioid mortality independent of the effect on pain. States that enacted medical cannabis laws had a 25 percent reduction in opioid overdose mortality.

Sixth, we need to replace the war on drugs with a public health policy. History shows that law enforcement as a first-line solution for drug epidemics has limited effects. It is also expensive: One year of incarceration costs taxpayers $24,000, compared with $4,700 for one year of methadone treatment.

Seventh, as with the tobacco industry, drug companies that contributed to the opioid crisis must pay penalties and help fund solutions.

The scourge of opioid addiction is a national emergency with no end in sight. More people die each month from opioids than died in the terrorist attack on Sept. 11, 2001. As the world recognizes International Overdose Awareness Day on Aug. 31, people need to start demanding leadership from their elected officials and health care executives. We can end these needless deaths, but only if public and private entities are willing to implement these solutions.

Kantarjian, M.D., is a nonresident Fellow in Health Policy at Rice University’s Baker Institute and is chairman of the Leukemia Department at The University of Texas MD Anderson Cancer Center. Jones is a medical student interested in health-care policies and problems.